akflightmedic

The caveat for the mental illness was if they are UNABLE to do the job OR incidents like what the original topic was about occurred, then yes, they need a new job. I did not say terminate them just for the sake of terminating. I did say if they lied on the application or tried to circumvent a pre employment screening, then yes because they lied, not because they have the condition. So, if one can NOT do the job or has serious incidents due to a condition, then yes I could fire them without remorse. Knowing that they may kill themselves by a job loss only reinforces the belief that they should not have been employed to start with. They are definitely unstable and it is NOT the employer's responsibility to base justified terminations on what the potential outcome in that individuals life may be. If this describes you, please get a mental screening or a hobby.

And my question which you ignored was Is it the employer's responsibility to maintain your personal happiness? You said if they took that away for whatever reason, what else would you have to live for. This was in agreeance with the guy who killed himself after the "last straw" of losing his job. Are you implying that an employer should consider the ramifications of terminating an employee in regards to their mental health and whether or not they would do something stupid (suicide)? Should they keep someone on staff to prevent this? Is that their obligation? Words of wisdom follow: EMS is what we do, it is NOT who we are.

So your personal happiness is now the responsibility of your employer, regardless of you being qualified or capable of the job? They should not do what is in their best interest in order to preserve your happiness which is solely dependent upon a job??? Such odd thinking...

They are a 3. The lowest GCS score possible.

This is where the pre employment screening comes into play. If they are not weeded out initially, then they are good to go. If they develop it after their employment started, then so be it. You can't fire them for that. But if they lied on a pre employment medical and are caught later, then yes, they should be terminated. This is the only way you could legally terminate them providing there was no wrong action to speak of. No, not everyone in EMS or Fire is 100% healthy. Yes, we all have issues. However, there are some issues that should be controlled or even prevented from entering the workforce. Sorry, but no where does it say you are guaranteed the career of your choice simply because you want it. I have been turned down for a career that I really wanted for many years and feel I would be good at, but it just is not possible. There is no reason for me to piss and moan about it.

No ruff and your comparisons are not appropriate. Most seizure history patients would not be working on an ambo in my state to start with unless they have been sz free for 5 years. As for the diabetic that is not relevant. The diabetic would present a whole lot sooner than the bipolar patient. While I do not wish to give a complete lecture here, before you can post your opinion on this subject you need to do some homework and research bipolar. Forget what you have heard or what you think you know about it from watching tv or that Richard Gere movie many years ago. This is a mental disease process that never goes away; the symptoms are merely controlled by medication (these people are extremely sedate when on meds) or by following strict routines. The cycles are recognized by family or friends that are aware of the condition and know to look for the signals that indicate a cycle is being entered. Cycles last anywhere from weeks to months and occasionally get closer together. The flip of a switch bipolar is a rare one indeed. Many people who say they are and use it as an excuse for behavior are usually not truly bipolar. When on meds, the typical patient experiences one of two things. 1. They start to feel fine and stop their meds as they dont need them anymore because they are now "normal". This is part of the mania and the patient will believe it regardless of their medical training. Once off the meds they experience mania. Actually it is more of a hypomania and if you do not know the person, you would never know what they are experiencing. They can hide it very well. 2. Patients get tired of being a zombie and come off their meds, because it sucks to get through the day with your head in a fog. They also start thinking of how much better they were when they didnt take these drugs. Unfortunately, true biploar patients go on and off their meds all the time for the above reasons. They really can not be trusted regardless of their education or medical experience level. As I said earlier, a strong support system is necessary for most to lead a normal life without leading themselves or their families into ruin from their actions or non actions. This is a mental illness and you can not compare it to a physical disease process. If they are able to retain her in a non EMS role, great! If they cant or wont (their prerogative), then yes she should be dismissed. Find another career that is more suitable to your illness. Working in EMS is not a right and not everyone is cut out for the job. I am glad people have a touchy feely personality and want to help others, but choose a different route to satisfy those personal needs. The pre employment screenings is one of the things I love about the FD process. They clear you medically, physically and mentally. I think in the long run this produces a more safe environment for all the employees. No, I don't want us all to go Fire, but I do wish we used more discretion in the EMS hiring process.

How do you say that? Can you do it phonetically with the emphasis where it needs to be? Is it per sev o rating?

Sorry but the employee needs a new job. Hopefully a desk job with billing or supply is possible for this individual. Michael did one of the best explanations I have ever seen. I will not get in to my back story on this subject but I do have intimate knowledge and experience of this condition with someone close to me. It is one of those diseases that no one understands until it affects them personally. It is fun to make fun of and easily diagnose someone as bipolar as I have heard it many times. First off, like ADHD, there are many different types of bipolarism, each with their own unique trademark. One of the most successful treatments for all the types, aside from a supportive family or friend is ROUTINE. They have to have a very reliable, straightforward routine daily. This helps them maintain a grip on their diseases. EMS is anything but routine. The sleepless nights, surges of adrenaline, the unknowing of what is next, are all the things a person with bipolar does NOT need. I do agree with Rid with regards to the pre employment screenings. The PD and FD have been doing it for years as I have sat through a few of them myself. (Yes I passed )

Sorry but I feel the need to respond to this one. I will say I used to feel the same way before I started flying and I was a Paramedic!! It irked me to no end that they would jump in and barely look at me, much less acknowledge they were listening. After I started flying, I realized I was doing the same thing for several different reasons. First, I was familiar with the services in my area. I knew their capabilities and limits. Honestly, as a basic on the ground for 20 mins with my patient, there is VERY LITTLE you can tell me that I will not find on my own in a minute or less when I perform my exam. There is also very little you can tell me that will change ANYTHING I need to do for the patient, the care rendered will remain unchanged. I am going to do my exam anyways, so please feel free to continue talking while I do it. I will also be listening to breath sounds almost immediately when I approach the patient, so don't let that bruise your ego when I plug in while you are mid sentence. Time is of the essences and there are things I need to assess and interventions to perform. I do not need a play by play of the past 20 minutes. It is irrelevant. Once I feel I have all pertinent information (Notice I said me and not you) I will dismiss you and say thank you. This is not social hour and I will not ask about you or your family. My thoughts are entirely on the patient and the care. I will come across as gruff or even rude, but you know what, I do not care at that moment as it is neither about me nor you. I am being professional and giving my undivided attention to this patient that necessitated a helicopter response. When receiving a patient from a medic, I do extend a little more attention (depending on the medic, how they are acting, what they are saying) because there initial findings are more relevant if they did indeed observe something pertinent. I also take the time to quickly assess the patency of their IVs or check tube placement prior to moving the patient. If I walk up and they start spewing off irrelevant details or sounds as if they do not know what they are talking about, I start my exam from scratch and acknowledge them the same way I would a rural vollie BLS squad. I do not have time for mediocrity and neither does the patient. All of this may sound snooty and some may say "he forgot where he came from", but that is so far from the truth. It is BECAUSE I remember where I came from that I do these things. It is called professionalism. I invite any of you to do grand rounds with a trauma surgeon and see how quickly you get eaten alive with the typical EMS education. You think feelings get hurt on this board...you have no clue.

So because of your military training and ability to improvise, you think it is perfectly acceptable to walk in the room with nothing?? How professional is that? You show up in a fully stocked ambulance with portable bags/equipment and you may choose to not bring it? What do you do, ask the patient's family for towels to control the bleeding? Sorry, in line stabilization is not major priority, you can tell the patient not to move until you are ready to dedicate a set of hands to that patient's c-spine. You are not saving any lines by simply manually holding c-spine. Bleeding control, again why would you not come in with necessary materials to control it? Yes, you can use anything around you but that is just tacky, unprofessional and stupid when it could of came in with you to start with. Seriously, your comment did nothing to promote professionalism within our field. Now I know at the end, you said if you happen to come up on it...but I do not understand when that would be. If you mean in a store or public gathering, ok, but in general we do not just "come up" on things. Whackers do tend to look or listen for such events on their radios or scanners and then place themselves in the area so that they do "come up on it", but it is not a regular occurrence with most professional EMS'ers.

Dont know what EMMA is or what you mean by COde3, but.... the avergae call takes me 10-15 minutes. A cardiac arrest 15-20 mins as well or longer (depending on how long my P takes to restock...lol) Now a really decent medical call or fubar trauma...about half hour only cause I have to reread usually for typos. I say half hour cause I leave it and then come back a few minutes later with fresh eyes.

If you are going to use the TIC, it is DCAP BLS TIC. (Have to drop the first T, otherwise you repeat yourself) TIC is Tenderness, Instability, and Crepitus. Can you explain the ASPN?

I have had two past partners opt for gastric bypass. They were back at work in no time, 6-8 weeks if I recall correctly. They did fine on the job, didn't seem to affect them any. More recently as in 7 months ago, a medic buddy of mine here went and had the band placed. He hast dropped over a hundred pounds so far. After hearing about the two, I personally would choose the band for starters, much less invasive and back to work in no time. He is also able to adjust the band should he decide he wants to intake more food for any particular reason. It is kind of like a port and he just sticks himself and makes it smaller or larger. Sorry I cant be more technical, but being an observer of the two different route, I would definitely go for the band.

Yes, that one is an old one. I have used it and taught it. It is great for test taking purposes. In the field, I can say I have never used it for treatment or diagnosis purposes. While we are at it, let me give you another one I have posted before. Its been a few years but there are fresh crops here so we will rehash it. Take this one back to your instructor. How to remember the different types of shock. SHRIMP CAN Septic Hypovolemic Respiratory Insulin Metabolic Psychogenic Cardiogenic Anaphylactic Neurogenic

This is my point. How do you know what you need until you assess and know what you need? I personally do not wish to be on the 20th floor of a hotel, or several floors up in a high rise only to determine that I should have brought my ALS kit. I do not wish to rely entirely on a second crew or the FD. Even going into a single level house, the bags go with us. I forgot to mention the one thing that I am notorious for leaving behind on the unit. That is the CLIPBOARD!! I always forget the clipboard, cause quite frankly I do not write much down on scene, never had a need to. Now if the patient is a refusal, this is when I send my partner or FD with equipment in hand to return to the truck and fetch me a clipboard. I even started placing a refusal or two inside the monitor to prevent such situation after a while. Of course, all this changed when we got our PDAs and did everything on them. Since I was the senior, I just put my partner in charge of it to ensure we always had it when we needed it. Nothing like delegation! But seriously, how many calls you have been dispatched to that were actually what they said with nothing more to it, or not the symptoms of a more serious issue?

I guess no one reads the fine print anymore.....

I fly international, a lot. I have encountered many emergencies during flight. I usually sink down in my seat when they call for help over the PA, unless someone doesn't answer by the 2nd or 3rd call. A few times, after boarding, I have informed the attendant in my area of my certification level. They do write this information down and will come to you discretely instead of calling for help over the PA. It prevents gawkers, embarrassment and a lot of people from getting worked up over nothing. I have been used several times and usually don't mind as it does have its perks depending on which airline you are on. On two of the occasions, when I was asked for help, it was a non life threatening situation, so they asked to see my licenses. They then wrote down all the information and allowed me access to the patient. I also had to sign a form that made me a "temporary" employee of the airline after they verified my certs. After aiding the patient with their consent, I then terminated my employment. No, they do not pay you but they do find a way to upgrade your experience either on this flight or a future flight. My first glass of Dom was "payment for services rendered". I found it ironic that they gave me alcohol when there was still 5 hours of the flight left...LOL. I have also worked a code and a syncope patient during flight. The code was futile and after exhausting resources, the process was to move the body to 1st class and cover it. It is silly to divert or reroute simply to offload a body. It would cost the airline way too much money to do this kid of thing and from a business perspective, it is a smart decision. The syncope patient was fun. It got me moved to 1st class, so I could be near the patient in case something else happened. During my assessment of the syncope patient, the attendant called the airlines medical control. I had to tell the Doc my findings, what I did or intended to do and whether or not we should continue the course or divert. This made me nervous, cause I suddenly realized the importance of my decision. I could divert and offload and screw up several hundred other people or I could declare her stable and continue the course; and if I declared her stable and we continue, what do I do if she becomes unstable. Very big decisions to be made. We stayed the course and the patient was fine. Upon landing the medics came on board and treated me like shit and didn't care what report I had to give them, but whatever.....

Wow! There is no mention of the MT cylinder. I always ask my students about this one, they never seem to have heard of it either but little do they realize, they will encounter this cylinder many times during their career. If you don't understand, say MT out loud, fast.

Those devices you fetch later unless you have knowledge of a patients location. For example a 2 story house and you know the pt is upstairs, you may want to go ahead and have the 3rd set of hands bring it in or your partner fetch it after you go in and make initial contact and determine severity,etc. If I am responding to a confirmed cardiac arrest, the LSB (backboard) goes on the stretcher and the patient is rolled onto it almost immediately before airway or lines are placed. Less chance of something being yanked by accident.

Good thread. When I worked stateside... My O2 is always connected to the stretcher or I have an airway bag with everything in it. The drug bag has BP cuff, steth, pulse ox, and few basic bandaging supplies and 2 IV start kits with 2 bags of fluid as well as the drugs. The monitor ALWAYS goes. The bag goes on the stretcher and the stretcher goes with me as close as possible to the patient. I have been burnt by not having the cot or other items with me when it is a "stubbed toe" that turns into a cardiac arrest. Suction usually rides along too depending on nature of call. I always have a Vvac (hate them) in the airway bag, so occasionally I bring the big dog. Early in my career, two medics were fired and two others reprimanded for not having suction on scene of a kid with a crushed larynx. No protocol for surg cric at the time and it would not have made a difference. However the county needed a scape goat due to pressure form the parents and they determined that the child's condition could have improved had suction been on scene. Never mind the fact he was hit by a baseball bat in the throat. I do not allow my partners or students to ever go anywhere empty handed. I try to get them in that mindset before they venture out on their own. Whats the harm of having equipment there and not needing it? At the very minimum, we get a little exercise which benefits us all. One of my pet peeves is when someone runs ahead of me empty handed. But yes, everything goes on every call. I forgot to address policy. We had county policy that at the very minimum, you had to enter with airway bag and monitor on every scene. If you needed something else, FD would fetch it, but usually to present a professional image, we had everything we needed to do our job right there.

OK, they have changed the site and I could not locate the information. However, in the past when you were certified close to the set expiration time frame (for example you get certed in November and everyone expires in Dec), you were automatically renewed to the next expiration period since FL likes everyone to expire at the same time. My best advice to you, is to NOT ask your buddy, NOT to ask your supervisor, and NOT to ask anyone on a web board. Instead, pick up a phone and call. Set aside the time to take care of an issue that greatly impacts your certification. In my past experiences, they were always easy to get a hold of and surprisingly had reliable information as opposed to the above mentioned sources. Here is the number Emergency Medical Tech (EMT) = (850) 488 - 0595 Good luck!

As an EMT, when are you using this PASTE device? As for the second one "TEMPRDS", I guess someone decided to make that up instead of using the 5 rights that the rest of the professional medical community uses?? (6 rights if you count right to refuse)

What is PASTE and what is TEMPRDS?

:oops: :oops: 5 months (3 nights a week, occasional Sat) and 1500 dollars I even had to get a bank loan to pay this outrageous tuition!! Ok, this was many moons ago but....

I agree with Rid, valid points as always. At this time, I am not involved on a national level, only informed. I am active at the local and state level in Florida and have been for many years. Currently I am a member of the Florida Association of EMS educators. http://www.faemse.org/index.shtml We have two position statements of which I disagree with the first one. Getting this stuff changed at the state level will be crucial to us ever changing anything at the national level. (click the link and go read it) I know it isn't much but it is the least I can do right now with all my traveling over the past few years.